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Contemporary Procedural Trends of Watchman Percutaneous Left Atrial Appendage Occlusion in the United States
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  • Muhammad Bilal Munir,
  • Muhammad Khan,
  • Douglas Darden,
  • Deepak Kumar Pasupula,
  • Sudarshan Balla,
  • Frederick Han,
  • Ryan Reeves,
  • Jonathan Hsu
Muhammad Bilal Munir
West Virginia University School of Medicine
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Muhammad Khan
West Virginia University Hospitals
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Douglas Darden
University of California San Diego Health System
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Deepak Kumar Pasupula
UPMC Passavant
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Sudarshan Balla
West Virginia University Hospitals
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Frederick Han
University of California San Diego Health System
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Ryan Reeves
UCSD
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Jonathan Hsu
University of California, San Diego
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Abstract

Objective: To determine trends in real-world utilization and in-hospital adverse events from Watchman implantation since its approval by the Food and Drug Administration in 2015. Background: The risk of embolic stroke caused by atrial fibrillation is reduced by oral anticoagulants, but not all patients can tolerate long-term anticoagulation. Left atrial appendage occlusion with the Watchman device has emerged as an alternative therapy. Methods: This was a retrospective cohort study utilizing data from National Inpatient Sample for calendar years 2015-2017. The outcomes assessed in this study were associated complications, in-hospital mortality, and resource utilization trends after Watchman implantation. Trends analysis were performed using analysis of variance. Multivariable adjusted logistic regression analysis was performed to determine predictors of mortality. Results: A total of 17,700 patients underwent Watchman implantation during the study period. There was a significantly increased trend in the number of Watchman procedures performed over the study years (from 1,195 in 2015 to 11,165 devices in 2017, p < 0.01). A significant decline in the rate of complications (from 26.4% in 2015 to 7.9% in 2017, p < 0.01) and inpatient mortality (from 1.3% in 2015 to 0.1% in 2017, p < 0.01) were noted. Predictors of in-hospital mortality included a higher CHA₂DS₂-VASc score (OR 2.61 per 1-point increase, 95% CI 1.91-3.57), chronic blood loss anemia (OR 3.63, 95% CI 1.37-9.61) and coagulopathy (OR 4.90, 95% CI 2.32-10.35). Conclusion: In contemporary United States clinical practice, Watchman utilization has increased significantly since approval in 2015, while complications and in-patient mortality have declined.

Peer review status:UNDER REVIEW

12 Sep 2020Submitted to Journal of Cardiovascular Electrophysiology
14 Sep 2020Assigned to Editor
14 Sep 2020Submission Checks Completed
18 Sep 2020Reviewer(s) Assigned